Mandi Schwartz Update: Transplant Schedule Set

Mandi Schwartz. (photo by Sam Rubin '95, Yale Sports Publicity)

Sep 15, 2010

Procedure Will Take Place Sept. 22

NEW HAVEN, Conn. – Following the results
of a recent biopsy, doctors at the Seattle Cancer Care Alliance
have determined a schedule for the stem cell transplant Yale
women's hockey center Mandi Schwartz needs to help win her
battle with cancer. The transplant, which will utilize stem cells
from two umbilical cord blood units donated anonymously to public
cord blood banks, is now scheduled for Sept. 22 at the Seattle
Cancer Care Alliance's inpatient transplant unit at the
University of Washington Medical Center.

Mandi, a native of Wilcox, Sask., has been battling acute
myeloid leukemia for nearly two years. She needs a stem cell
transplant -- essentially, a new blood and immune system -- to
survive. Stem cells have the ability to change into any of the
body's cell types. In Mandi's case, they will be used
to give her new blood cells and new immune cells. Her current
immune system, along with the cancerous cells, will be wiped out by
chemotherapy and radiation in the next few days.

"The scheduling of the transplant gives us reason for
optimism," said Rick Schwartz, Mandi's father.
"Mandi has kept up a positive attitude throughout this whole
process, and we are looking forward to the day when she can be
declared cancer-free. We continue to be thankful for all the
support that we have received, and for the efforts of the doctors
at the Seattle Cancer Care Alliance. Please continue raising
awareness of the need for bone marrow donors and umbilical cord
blood donors to save the lives of all patients who need transplants
like the one Mandi will receive."

The recent biopsy indicated 2.5 to seven percent blast cells in
Mandi's bone marrow. Blast cells are immature cells in bone
marrow that mature into white blood cells or red blood cells. They
normally account for up to five percent of the cells in bone
marrow, so a higher ratio than that can indicate a problem.

Mandi will undergo two one-hour sessions of radiation each day
from Sept. 15 through 17. She will then have two days of
chemotherapy, Sept. 19 and 20. This is designed to ensure that all
of the existing cancerous cells in Mandi's body are
eliminated. This will also further suppress Mandi's immune
system to prevent her from immediately rejecting the new donor
cells.

"The final words from her SCCA team nurse were for
her to prepare herself mentally and to think of this as the
toughest hockey game she has ever yet played," Mandi's
mother, Carol, wrote on her CaringBridge website. "She is to
focus on never giving up during this game and on emerging the
winner!!! I warned the nurse that her medical team
ought to look out for the odd body check if this is how she is to
prepare because she can be one very aggressive girl.......she will
win!!!!"

The transplant itself is similar to a transfusion and takes a
few hours. The stem cells are placed in the body through a vein,
and find their way to the bone marrow to create new blood cells and
immune cells. After that the next big milestone is
"engraftment" -- the transplanted stem cells beginning
to grow in Mandi's bone marrow and manufacture new blood
cells and immune cells. This signifies the birth of Mandi's
new immune system, and should happen within a month of the
transplant.

Complete recovery of Mandi's new immune system takes
approximately a year, but could take longer if she develops any
complications as a result of the transplant. Following the
transplant, she will be monitored regularly through blood tests to
confirm that new blood cells are being produced. She will spend
several months in Seattle before she can return home to
Saskatchewan.

The original plan was to have Mandi receive cord blood that had
its number of stem cells "expanded", or increased, in
order to speed up the time to engraftment. Because of the results
of the recent biopsy, she will now receive a transplant from units
that have not had their number of stem cells expanded.

Here is a look at some of the key elements to
Mandi's battle:

About Acute Myeloid Leukemia

Acute myeloid leukemia is a type of cancer that starts inside
the bone marrow and grows from cells that would normally turn into
white blood cells -- cells of the immune system.

Treatment Back Home in Saskatchewan

Mandi was initially diagnosed with acute myeloid leukemia in
December of 2008, near the end of the first semester of her junior
year at Yale. She returned home to Saskatchewan for treatment at
the Allan Blair Cancer Centre in Pasqua Hospital in Regina. After
multiple rounds of chemotherapy she was first declared to be in
remission in the spring of 2009. She returned to Yale in January of
2010 and resumed practicing with the women's hockey team, but she
was re-diagnosed this past April and had to return home for more
chemotherapy. At that point it became clear that she would need a
stem cell transplant to survive, and her family chose to have the
transplant through the Seattle Cancer Care Alliance. Her
chemotherapy in Saskatchewan put her in remission, which is
necessary in order for her to be able to receive the stem cell
transplant, for a second time. She was found to be in remission on
June 9, and was discharged from Pasqua Hospital on July 11. That
enabled her and her family to make the trip to Seattle and begin
preparing for the transplant.

Attempts to Find a Genetic Match for Mandi

The stem cells for transplants like the one Mandi needs can come
from the bone marrow or peripheral blood of an adult donor or the
blood left over in the umbilical cord after a baby is born. In
order to limit the risk of complications, the stem cells must come
from a donor who is a close genetic match to the patient.

For transplant purposes, genetic matches are judged by comparing
proteins -- or markers -- found on most cells in the human
body. The immune system uses these markers, known as human
leukocyte antigens (HLA), to recognize which cells belong to that
body and which do not. A close match between HLA markers can reduce
the risk that the recipient's immune cells attack the donor's
cells or that the donor's immune cells attack the recipient's
body after the transplant. There are many different HLA markers,
but transplant donors and patients are primarily compared for
matches of eight to 10 markers that are most important in
transplant outcomes.

Mandi has been unable to find a bone marrow donor that is a
genetic match -- 16,000 leukemia patients diagnosed each year
cannot. None of her family members are matches. Inspired by Mandi,
bone marrow donor drives have been held throughout her native
Canada and the United States. The Yale Athletics Department has
held drives each of the past two springs, adding more than 1,600
people to the National Marrow Donor Program's "Be The
Match" registry. A series of drives in Canada added more than
2,600 people to Canadian Blood Services'
"OneMatch" registry. The people that registered at
these drives may be called upon someday to help save the life of a
patient, like Mandi, with a life-threatening illness.

The Umbilical Cord Blood Option

With no matching stem cell donor available, the best option is
to get the stem cells for the transplant from umbilical cord blood.
Cord blood has advantages as a stem cell source: fewer viral
infections are transmitted with it, and -- because umbilical cord
blood lacks well-developed immune cells -- there is less chance
that the transplanted cells will attack the recipient's body
(graft-versus-host disease). Using cord blood thus does not require
the extremely close genetic matching of bone marrow
transplants.

The disadvantage to using umbilical cord blood for a transplant
is that each unit has fewer stem cells than other sources
(approximately 1/10th). Because of this low number,
engraftment (the generation of infection-fighting white blood cells
of the new immune system following transplantation) in adults from
a cord blood transplant takes about 26 to 28 days, compared to 15
for a bone marrow transplant. While waiting for engraftment
patients run the risk of getting infections.

When the Schwartzes were looking for a hospital for the
transplant, they were drawn to Seattle Cancer Care Alliance, which
is operated by Fred Hutchinson Cancer Care Center, University of
Washington Medicine and Seattle Children's. They are working
with Dr. Colleen Delaney, an oncologist and researcher in Dr. Irwin
Bernstein's Clinical Research Division lab. Mandi and her family
have met with Dr. Delaney and the transplant team to prepare for
the transplant. Mandi's attending physician is Dr. Paul
Martin, a medical oncologist.

The Family in Seattle

Mandi, her parents Carol and Rick, and her fiancée,
Kaylem Prefontaine, made the trip to Seattle from their home in
Saskatchewan by an RV donated by Traveland RV in Regina.
Mandi's younger brothers, Jaden and Rylan, have both spent
time visiting her in Seattle as well. They are hockey players at
Colorado College, and Jaden was recently selected in the first
round of the NHL Draft by the St. Louis Blues.

The Cord Blood Selected for Mandi's
Transplant

The cord blood units that will be used in Mandi's
transplant came from two separate donors who are, and will remain,
anonymous. They were donated to public cord blood banks and located
by a registry search performed by the Seattle Cancer Care Alliance.
The units are each identified as "5-out-of-6" genetic
matches for Mandi. Because umbilical cord blood stem cells require
less strict matching criteria, transplants can be performed even
with "4-out-of-6" matches.

The Transplant

On Aug. 11 -- just 16 days before her originally scheduled
transplant date – a biopsy indicated that Mandi's
cancer had returned. The transplant had to be postponed as she
underwent another round of chemotherapy. After being
discharged from the hospital when that round finished on Aug. 19,
tests indicated that she was in remission.

In preparation for her transplant, chemotherapy and total-body
radiation will be used to ensure that all of the existing cancerous
cells in Mandi's body are eliminated. This will also further
suppress Mandi's immune system to prevent her from
immediately rejecting the new donor cells.

The transplant itself is similar to a transfusion and takes a
few hours. The stem cells are placed in the body through a vein,
and find their way to the bone marrow to create new blood cells and
immune cells.

After the Transplant: Waiting for
Engraftment

After the transplant, the next milestone that everyone will be
watching for is known as "engraftment": the
transplanted stem cells beginning to grow in Mandi's bone
marrow and manufacture new blood cells and immune cells. This
signifies the birth of Mandi's new immune system, and could
happen within a few weeks of the transplant.

Complete recovery of Mandi's new immune system takes
approximately a year. Following the transplant, she will be
monitored regularly through blood tests to confirm that new blood
cells are being produced. She will spend several months in Seattle
before she can return home to Saskatchewan.

Yale Teammates Take Action

While Mandi's transplant will utilize cord blood, the need
for bone marrow donors for patients like her remains great. Mandi
and her family continue to encourage all adults to sign up as bone
marrow donors, and for expectant mothers to sign up as cord blood
donors.

In order to raise awareness of the need for bone marrow donors
and umbilical cord blood donors in general, and to help the
Schwartz family with expenses, Mandi's Yale teammates have
been organizing several events. Rising junior forward Aleca Hughes (Westwood, Mass.) raised nearly $6,000 and added
approximately 70 people to the bone marrow donor registry at the
Chowder Cup Tournament last month. On Aug. 26, rising senior
defenseman Samantha MacLean (Mississauga, Ont.)
completed a five-day, 500-mile bike ride from Toronto to New Haven,
"The Ride for 17" (Mandi's uniform number), to raise
awareness and funds. She brought in nearly $3,000.